=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821338542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON NICOLE HALL APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2013
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2881 HYDE PARK ST
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-3228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-906-7155
-----------------------------------------------------
Fax | 941-330-2905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 943 S BENEVA RD STE 306
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34232-2499
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-955-1108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 9204046
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------